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Cureus Mar 2024The purpose of orthodontic therapy is to correct malocclusion and produce a stable outcome that endures over time. Long-term stability can be difficult to achieve, and... (Review)
Review
The purpose of orthodontic therapy is to correct malocclusion and produce a stable outcome that endures over time. Long-term stability can be difficult to achieve, and many patients relapse after treatment, particularly in instances of open bite relapse (OBR). This systematic review aimed to analyze different types of management strategies for OBR and conduct a meta-analysis to find the best method of dealing with relapse. A comprehensive search was carried out across six major online databases using relevant keywords pertaining to our study, including "open bite relapse," "orthodontic retention," "orthodontic surgery," "orthodontic appliance," "orthodontic management," "orthodontic treatment," "orofacial myofunctional therapy (OMT)," "skeletal anchorage," and "treatment follow-up period." Eleven studies were selected after the application of relevant inclusion and exclusion strategies. The mean follow-up period of treatment for the studies ranged from six months to 4.5 years. Of all the management strategies assessed, OMT was found to be the least effective for OBR management. Surgical management modalities, such as mandibular repositioning and molar intrusion using skeletal anchorage, in conjunction with the usage of orthodontic appliances, were found to be noticeably effective, especially in the cases of participants who were <18 years of age. However, when utilized on a singular basis, either of them was found to be lacking the desired effect. The overall odds ratio (OR) of 0.48 (0.37, 0.64) and risk ratio (RR) of 0.62 (0.51, 0.74) were obtained after the meta-analysis of the different interventions for OBR, indicating statistical significance. There were only 11 studies included in the study, so it's possible that not all management strategies for OBR were fully understood. The limited number of studies may also have affected the generalizability of the findings. Although statistical differences were obtained to a certain degree, more clinical trials are needed to assess the effect of such surgical modalities as a viable management tool for OBR, since these represent a significant limiting factor in terms of the overall cost of the treatment placed upon the patient. Prior to the start of the research, registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The research protocol was created to meet the goals and was properly filed with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023401991).
PubMed: 38623106
DOI: 10.7759/cureus.56285 -
Journal of Dental Research, Dental... 2023Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the... (Review)
Review
BACKGROUND
Posterior intrusion with skeletal anchorage is one of the effective methods in the treatment of anterior open bite. Knowing the effects of posterior intrusion, the amount of possible molar intrusion using skeletal anchorage, and its impact on clinical and cephalometric indicators can help the clinician choose the optimal treatment method, especially in borderline surgical cases.
METHODS
In this systematic review, a series of articles were collected through a systematic search in databases, and the titles and summaries of all these articles were reviewed. After removing the irrelevant articles, the full texts of the related articles were read carefully, and their validity was evaluated. Only RCTs and observational studies that complied with PICO questions were included. The Cochrane Risk of Bias 2.0 (RoB 2), ROBINS-I, and GRADE were used to assess the risk of bias in the included studies. The relevant information on selected articles was extracted, and a meta-analysis was performed with Review Manager 5.4 software.
RESULTS
The meta-analysis revealed a significant average molar intrusion of 2.89 mm using temporary anchorage devices (TADs). A subgroup analysis showed that miniplates achieved greater intrusion (3.29 mm) compared to miniscrews (2.25 mm) (=0.03). The level of applied force did not significantly affect the degree of intrusion. Dental parameters such as overbite and overjet were notably altered, with overbite increasing by 4.81 mm and overjet decreasing by 2.06 mm on average. As for the skeletal cephalometric characteristics, SNB, ANB, and SN-Pog increased while mandibular plane angle and lower anterior facial height (LAFH) decreased, and these changes were significant. Meanwhile, SNA and palatal angle changes were not significant.
CONCLUSION
TADs have proved effective in achieving significant intrusion of maxillary molars, leading to marked improvements in dental and skeletal characteristics in patients with open bite malocclusion. Miniplates proved more effective in achieving greater intrusion.
PubMed: 38584993
DOI: 10.34172/joddd.2023.40754 -
BMC Oral Health Feb 2024Moebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral...
BACKGROUND
Moebius syndrome (MS) is a rare, non-progressive, neuromuscular, congenic disease involving the oral maxillofacial region. The present study aimed to describe the oral and extraoral findings in MS patients and their comprehensive dental management.
METHODS
A digital search was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, restricted to articles in English from Jan 01, 2000, to Apr 02, 2023, following PRISMA guidelines. The methodological quality of the studies was evaluated following the JBI guidelines. Qualitative analysis was carried out on the overall result, extraoral and intraoral manifestations, considering dental management as appropriate.
RESULTS
Twenty-three studies were included, and a total of 124 cases of patients with MS were analyzed. The 82% of patients with MS were younger than 15 years of age. The most frequent extraoral manifestations were blinking and visual problems (78,22%), malformations of the upper and lower limbs (58,22%), bilateral facial paralysis (12,90%), lack of facial expression (12.09%), and unilateral facial paralysis (6,45%). On the other hand, the most frequent oral manifestations were tongue deformities (78,22%), micrognathia (37,90%), labial incompetence (36,29%), cleft palate (22,87%), gothic palate (16,12%), microstomia (15,32%), anterior open bite (15,32%), dental caries (8,87%), and periodontal disease (8,06%). The majority of MS patients were treated by pediatric dentistry (60,86%), using a surgical approach (56,52%), and orthodontic and orthopedic maxillary (43,47%) followed by restorative (39,13%), and periodontal treatments (21,73%).
CONCLUSIONS
This systematic review demonstrates that patients with MS present a wide variety of oral and extraoral manifestations, for which dental treatments are planned and tailored to each patient in accordance with oral manifestations. These treatments encompass problem resolution and oral health maintenance, incorporating recent techniques in managing and treating patients with MS.
Topics: Child; Humans; Mobius Syndrome; Facial Paralysis; Dental Caries; Cleft Palate; Dental Care
PubMed: 38321523
DOI: 10.1186/s12903-024-03968-6 -
Cureus Oct 2023This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies...
This study presents a case series and systematic review of pediatric patients who sustained long bone fractures following dog bites. A systematic review of the studies on "pediatric fracture dog bite" based on a search of PubMed and OVID Medline databases was performed by adhering to PRISMA guidelines. Articles in English describing pediatric long bone fractures due to dog bites were included. Studies not differentiating pediatric from adult patients and not describing long bone fractures due to dog bites were excluded. Study characteristics, fracture epidemiology, management decisions, and follow-up data were extracted. Additionally, a seven-year retrospective chart review of cases treated at our level one pediatric trauma center was performed. Data on fracture characteristics, surgical management, choice of antibiotic therapy, and follow-up were collected. Five studies that met our criteria were analyzed. Pediatric long bone fractures from dog bites were identified in 0.35% (11/3,156) of patients. Such fractures most commonly involved the upper extremity (9/11, 82%). None of the studies described the choice of antibiotics, surgical decision-making, or wound closure preference for an underlying fracture. Our chart review elicited three cases of long bone fractures due to dog bites. Pediatric long bone fractures after dog bites are a rare injury pattern in the United States. These injuries should be treated as contaminated open fractures, and urgent immunization, intravenous antibiotic administration, wound care, and fracture stabilization should be provided. We recommend meticulous surgical debridement in the operating room, as wounds often probe deep into the bone. Nevertheless, there is much that remains unclear about these injuries. Hence, further research with greater power is needed to improve treatment decisions.
PubMed: 38022042
DOI: 10.7759/cureus.47230 -
Progress in Orthodontics Nov 2023To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of... (Review)
Review
AIMS
To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events.
METHODS
A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal.
RESULTS
A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low.
CONCLUSIONS
Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.
Topics: Humans; Maxilla; Root Resorption; Tooth Movement Techniques; Orthodontic Anchorage Procedures; Malocclusion; Open Bite; Molar
PubMed: 37953383
DOI: 10.1186/s40510-023-00490-3